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Journal of Cardiology Jun 2019Diastolic filling of the heart is a complex sequence of multiple inter-related events consisting of processes such as ventricular relaxation, erectile coronary effect,... (Review)
Review
Diastolic filling of the heart is a complex sequence of multiple inter-related events consisting of processes such as ventricular relaxation, erectile coronary effect, visco-elastic forces of the myocardium, ventricular interaction, myocardial stress strain relationships, pericardial restraint, passive filling, and atrial contraction. However, in order to understand diastolic filling from a clinical aspect, a simplified foundation can be used which divides the cardiac cycle into contraction, relaxation, passive filling, and filling at atrial contraction. The mitral flow velocity curves are representative of the relative driving pressure between left atrium and left ventricle and allow one to grade the progression of diastolic dysfunction which occurs in disease states. Doppler tissue imaging is necessary as a surrogate of ventricular relaxation to further determine the stages of diastolic dysfunction in patients with preserved ejection fraction. These Doppler flow velocity curves can be applied to understanding diastolic filling of the heart in patients with both reduced ejection fraction and preserved ejection fraction.
Topics: Cardiomyopathies; Diastole; Echocardiography, Doppler; Female; Heart Atria; Heart Ventricles; Humans; Male; Myocardial Contraction; Ventricular Dysfunction; Ventricular Function
PubMed: 30922613
DOI: 10.1016/j.jjcc.2019.03.002 -
Journal of Cardiovascular... Nov 2022Intracardiac echocardiography (ICE) has become an essential tool and is an integral part of percutaneous interventional and electrophysiology (EP) procedures.... (Review)
Review
Intracardiac echocardiography (ICE) has become an essential tool and is an integral part of percutaneous interventional and electrophysiology (EP) procedures. Intracardiac echocardiography offers real-time, high-quality, near-field evaluation of cardiac anatomy. Standard ICE imaging includes placing the catheter in the right atrium (RA), right ventricle (RV), or left atrium (LA, via the transeptal approach). Coronary sinus echocardiography (CSE) is another alternative, where the ICE catheter is positioned in the coronary sinus (CS). This approach offers better catheter stability and allows operators to visualize cardiac structure with particularly excellent views of the LA, LAA, left ventricle (LV), and mitral annulus. Additionally, CSE is an attractive alternative in cases with unfavorable interatrial septum or fossa ovalis anatomical features that could lead to difficulty advancing ICE catheter in left atrium. In this article focusing on CSE, we provide illustration-based guidance to help operators identify critical cardiac structures from CSE.
Topics: Humans; Coronary Sinus; Ultrasonography, Interventional; Echocardiography; Heart Atria; Mitral Valve; Cardiac Catheterization
PubMed: 36153661
DOI: 10.1111/jce.15687 -
Redox Biology Jun 2023Atrial remodeling is a major contributor to the onset of atrial fibrillation (AF) after myocardial infarction (MI). Tripartite motif-containing protein 21 (TRIM21), an...
Atrial remodeling is a major contributor to the onset of atrial fibrillation (AF) after myocardial infarction (MI). Tripartite motif-containing protein 21 (TRIM21), an E3 ubiquitin protein ligase, is associated with pathological cardiac remodeling and dysfunction. However, the role of TRIM21 in postmyocardial infarction atrial remodeling and subsequent AF remains unclear. This study investigated the role of TRIM21 in post myocardial infarction atrial remodeling using TRIM21 knockout mice and explored the underlying mechanisms by overexpressing TRIM21 in HL-1 atrial myocytes using a lentiviral vector. The expression of TRIM21 in the left atrium of the mouse MI model was significantly elevated. TRIM21 deficiency alleviated MI-induced atrial oxidative damage, Cx43 downregulation, atrial fibrosis and enlargement, and abnormalities in electrocardiogram parameters (prolongation of the P-wave and PR interval). TRIM21 overexpression in atrial myocyte HL-1 cells further enhanced oxidative damage and Cx43 downregulation, whereas these effects were reversed by the reactive oxygen species scavenger N-acetylcysteine. The findings suggest that TRIM21 likely induces Nox2 expression mechanistically by activating the NF-κB pathway, which in turn leads to myocardial oxidative damage, inflammation, and atrial remodeling.
Topics: Mice; Animals; Connexin 43; Atrial Fibrillation; Atrial Remodeling; Myocardial Infarction; Heart Atria; Oxidative Stress; Mice, Knockout; Inflammation
PubMed: 36996623
DOI: 10.1016/j.redox.2023.102679 -
Acta Medica Indonesiana Jan 2022Heart failure is the end of all pathological conditions in the heart. Most accepted paradigms in heart failure are always preceded by left ventricle disfunction.... (Review)
Review
Heart failure is the end of all pathological conditions in the heart. Most accepted paradigms in heart failure are always preceded by left ventricle disfunction. Currently, there are several clinical studies that show that heart failure may occur without prior left ventricular dysfunction. Left atrial dysfunction may play a more important role in heart failure than previously expected. Failure of the left atrium can exist independently of left ventricle dysfunction and mitral valve abnormalities. Atrial failure, just like left ventricular failure, can lead to global heart failure. Etiology, pathomechanism and clinical symptoms of atrial failure are complex and not well understood. This review will explain atrial failure.
Topics: Heart Atria; Heart Failure; Humans; Mitral Valve; Ventricular Dysfunction, Left
PubMed: 35398835
DOI: No ID Found -
JACC. Cardiovascular Imaging Jan 2021
Topics: Atrial Fibrillation; Heart Atria; Heart Failure; Humans; Predictive Value of Tests
PubMed: 33413884
DOI: 10.1016/j.jcmg.2020.09.012 -
Physiological Reports Oct 2021Three-dimensional echocardiography can elucidate the phasic functions of the left atrium if a simultaneous acquisition of a pyramidal full-volume dataset, as gathered... (Review)
Review
Three-dimensional echocardiography can elucidate the phasic functions of the left atrium if a simultaneous acquisition of a pyramidal full-volume dataset, as gathered from the apical window and containing the entire left atrial and left ventricular cardiac sections, is obtained. Hence, conduit can be quantified as the integral of net, diastolic, instantaneous difference between synchronized atrial and ventricular volume curves, beginning at minimum ventricular cavity volume and ending just before atrial contraction. Increased conduit can reflect increased downstream suction, as conduit would track the apex-to-base intracavitary pressure gradient existing, in early diastole, within the single chamber formed by the atrium and the ventricle, when the mitral valve is open. Such a gradient increases in response to adrenergic stimulation or during exercise and mediates an increment in passive flow during early diastole, with the ventricle being filled from the atrial reservoir and, simultaneously, from blood drawn from the pulmonary veins. In this context conduit, and even more conduit flow rate, expressed in ml/sec, can be viewed as an indirect marker of left ventricular relaxation. It is well known, however, that a large amount of conduit (in relative terms) is also supposed to contribute to LV stroke volume in conditions of increased resistance to LV filling, when diastolic function significantly worsens. Stiffening of the atrio-ventricular complex implies increments in LA pressure more pronounced in late systole, causing markedly elevated "v" waves, independently of the presence of mitral insufficiency. The combination of increased atrio-ventricular stiffness and conduit flow is associated with an elevation of the right ventricular pulsatile relative to resistive load that negatively impacts on exercise capacity and survival in these patients. Atrial conduit is an "intriguing" parameter that conveys a noninvasive picture of the complex atrioventricular coupling condition in diastole and its backward effects on the right side of the heart and the pulmonary circulation. Given the easiness associated with its correctly performed quantification in the imaging laboratory, I am sure that conduit will survive the competitive access to the list of valuable parameters capable of deciphering, although not necessarily simplifying, the complex diastolic scenario in health and disease.
Topics: Atrial Function, Left; Diastole; Echocardiography, Three-Dimensional; Heart Atria; Humans; Stroke Volume
PubMed: 34605214
DOI: 10.14814/phy2.15053 -
Kardiologia Polska 2021The speckle-tracking technique has become an easily accessible, quick-to-use, and straightforward tool for assessing advanced myocardial function. Achievements in the... (Review)
Review
The speckle-tracking technique has become an easily accessible, quick-to-use, and straightforward tool for assessing advanced myocardial function. Achievements in the analysis of the left atrium have demonstrated that it plays an important role in the physiology and pathophysiology of the circulatory system. Deformation analysis allows the detection of even subtle functional abnormalities when atrial enlargement is not yet detected. Thus, left atrial strain has a documented diagnostic and prognostic value in many clinical scenarios. Furthermore, this technique is increasingly entering routine clinical practice. The analysis becomes possible thanks to new tools that simplify the speckle-tracking assessment. Left atrial strain improves diagnostic possibilities of standard echocardiographic examination, and its diagnostic and prognostic value is sometimes comparable with more advanced and less available techniques. In this review, we discuss the principles of performing strain analysis and the results of current research, and thus the potential possibilities of sophisticated atrial assessment application in various clinical scenarios.
Topics: Atrial Appendage; Echocardiography; Heart Atria; Humans
PubMed: 34599503
DOI: 10.33963/KP.a2021.0105 -
European Journal of Heart Failure Jul 2020
Topics: Heart Atria; Heart Failure; Heart Valve Prosthesis Implantation; Heart Ventricles; Humans; Mitral Valve; Mitral Valve Insufficiency; Registries
PubMed: 32452145
DOI: 10.1002/ejhf.1863 -
Cardiovascular Ultrasound Feb 2021The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed...
BACKGROUND
The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed the structural and functional effects of severe AR on LV and left atrium before and after aortic valve replacement.
METHODS
Patients with severe AR scheduled for aortic valve replacement (n = 65) underwent two- and three-dimensional echocardiography, including left atrial strain imaging, before and 1 year after surgery. A control group was selected, and comprised patients undergoing surgery for thoracic aortic aneurysm without aortic valve replacement (n = 20). Logistic regression analysis was used to assess predictors of impaired left ventricular functional and structural recovery, defined as a composite variable of diastolic dysfunction grade ≥ 2, EF < 50%, or left ventricular end-diastolic volume index above the gender-specific normal range.
RESULTS
Diastolic dysfunction was present in 32% of patients with AR at baseline. Diastolic LV function indices and left atrial strain improved, and both left atrial and LV volumes decreased in the AR group following aortic valve replacement. Preoperative left atrial strain during the conduit phase added to left ventricular end-systolic volume index for the prediction of impaired LV functional and structural recovery after aortic valve replacement (model p < 0.001, accuracy 70%; addition of left atrial strain during the conduit phase to end-systolic volume index p = 0.006).
CONCLUSIONS
One-third of patients with severe AR had signs of diastolic dysfunction. Aortic valve surgery reduced LV and left atrial volumes and improved diastolic indices. Left atrial strain during the conduit phase added to the well-established left ventricular end-diastolic dimension for the prediction of impaired left ventricular functional and structural recovery at follow-up. However, long-term follow-up studies with hard endpoints are needed to assess the value of left atrial strain as predictor of myocardial recovery in aortic regurgitation.
Topics: Aortic Valve; Aortic Valve Insufficiency; Heart Atria; Heart Valve Prosthesis Implantation; Humans; Retrospective Studies; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 33583414
DOI: 10.1186/s12947-021-00243-4 -
JACC. Cardiovascular Imaging Aug 2020
Topics: Atrial Fibrillation; Contrast Media; Fibrosis; Gadolinium; Heart Atria; Humans; Predictive Value of Tests
PubMed: 32682723
DOI: 10.1016/j.jcmg.2020.04.023